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Open AcceReviewConceptual framework for a Danish human biomonitoring programMarianne Thomsen*1, Lisbeth E Knudsen2,3, Katrin Vorkamp3, Marie Frederiksen2, Hanne Bach1, Eva Cecilie Bonefeld-Jorgensen4, Suresch Rastogi3, Patrik Fauser1, Teddy Krongaard5 and Peter Borgen Sorensen6

Address: 1National Environmental Research Institute, University of Aarhus, Department of Policy Analysis, DK-4000 Roskilde, Denmark, 2Institute of Public Health, University of Copenhagen, DK-1014 København K, Denmark, 3National Environmental Research Institute, University of Aarhus, Department of Environmental Chemistry and Microbiology, DK-4000 Roskilde, Denmark, 4Unit of Cellular & Molecular Toxicology, Institute of Public Health, University of Aarhus, DK-8000 Aarhus, Denmark, 5National Environmental Research Institute, University of Aarhus, Department of Atmospheric Environment, DK-4000 Roskilde, Denmark and 6National Environmental Research Institute, University of Aarhus, Department of Terrestrial Ecology, DK-8600 Silkeborg, Denmark

Email: Marianne Thomsen* - mth@dmu.dk; Lisbeth E Knudsen - L.Knudsen@pubhealth.ku.dk; Katrin Vorkamp - kvo@dmu.dk; Marie Frederiksen - mafr@dmu.dk; Hanne Bach - hba@dmu.dk; Eva Cecilie Bonefeld-Jorgensen - ebj@mil.au.dk; Suresch Rastogi - scr@dmu.dk; Patrik Fauser - paf@dmu.dk; Teddy Krongaard - tek@dmu.dk; Peter Borgen Sorensen - pbs@dmu.dk

* Corresponding author

AbstractThe aim of this paper is to present the conceptual framework for a Danish human biomonitoring(HBM) program. The EU and national science-policy interface, that is fundamental for a realizationof the national and European environment and human health strategies, is discussed, including theneed for a structured and integrated environmental and human health surveillance program atnational level. In Denmark, the initiative to implement such activities has been taken. The proposedframework of the Danish monitoring program constitutes four scientific expert groups, i.e. i.Prioritization of the strategy for the monitoring program, ii. Collection of human samples, iii.Analysis and data management and iv. Dissemination of results produced within the program. Thispaper presents the overall framework for data requirements and information flow in the integratedenvironment and health surveillance program. The added value of an HBM program, and in thisrespect the objectives of national and European HBM programs supporting environmental healthintegrated policy-decisions and human health targeted policies, are discussed.

In Denmark environmental monitoring has been prioritized by extensive surveillance systems ofpollution in oceans, lakes and soil as well as ground and drinking water. Human biomonitoring hasonly taken place in research programs and few incidences of e.g. lead contamination. However anarctic program for HBM has been in force for decades and from the preparations of the EU-pilotproject on HBM increasing political interest in a Danish program has developed.

from Ethics and communication in human biomonitoring in Europe: results from preparation of pilot studiesCopenhagen, Denmark. 11–13 March 2007

Published: 5 June 2008

Environmental Health 2008, 7(Suppl 1):S3 doi:10.1186/1476-069X-7-S1-S3

<supplement> <title> <p>Ethics and communication in human biomonitoring: European perspectives</p> </title> <editor>Lisbeth E Knudsen, Franco Domenico Merlo and Ann Dyreborg Larsen</editor> <note>Reviews and Research</note> <url>http://www.biomedcentral.com/content/files/pdf/1476-069X-7-S1-info.pdf</url> </supplement>

This article is available from: http://www.ehjournal.net/content/7/S1/S3

© 2008 Thomsen et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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IntroductionSustainability and integrated protection of the environ-ment and human health are closely linked [1]. Denmarkhas developed a national strategy for sustainable develop-ment for which the main goal is a constant decrease inpollutant levels in products, food, the working environ-ment, traffic and the indoor environment [2-5]. The Dan-ish vision of sustainable development is based on eightobjectives and principles [2]:

1. The welfare society must be developed and economic growthmust be decoupled from environmental impacts.

2. There must be a safe and healthy environment for everyone,and we must maintain a high level of protection.

3. We must secure a high degree of bio-diversity and protectecosystems.

4. Resources must be used more efficiently.

5. We must take action at an international level.

6. Environmental considerations must be taken into account inall sectors.

7. The market must support sustainable development.

8. Sustainable development is a shared responsibility and wemust measure progress.

Objective 2 is further described in the section on the cross-cutting issue 'Environment and health' which states that:'Denmark should be a country where pollution from products,food, working environment, traffic and physical indoor condi-tions affecting the population's quality of life and health is con-stantly falling. Harm to animals and plants from pollutionshould also be limited. The protection level must take accountof especially sensitive groups of people – such as children, preg-nant women, people who suffer from allergies or from chronicillness – and of particularly vulnerable ecosystems' [2].

In 2003, the European Commission launched the Euro-pean Environment and Health Strategy [6,7]; a strategy toreduce diseases linked to environmental factors. The strat-egy, also known as SCALE, comprises the development ofinformation systems as well as the compilation of ade-quate political measures. Its themes are: Scientific evi-dence, focus on Children, raising of Awareness,improving the situation by use of Legal instruments andallowing Evaluation of the progress made.

In the same year, Denmark published a backgroundreport [8] for a strategy and action plan to protect publichealth against environmental factors [9]. The strategy

addresses chemicals with respect to their harmful effects,which is also addressed in the overall Danish chemicalsstrategy. The action plan includes a ten-point plan:

1. Negative impacts from chemicals are to be reduced, and thesubstitution of hazardous substances by less hazardous onesmust be accelerated

2. The incidence of allergy and respiratory disorders is to bereduced

3. Measures directed at endocrine-disrupting substances are tobe intensified

4. Noise nuisance is to be reduced

5. The negative impacts on health from air pollution and fromthe indoor climate are to be reduced

6. Food is to be safe and free from pollution

7. Groundwater and drinking water must be protected

8. Research into the significance of environmental factors onhealth is to be enhanced

9. Cooperation between the authorities must be strengthened

10. Increased attention must be accorded to environmental fac-tors and health in international cooperation

Human biomonitoring is only addressed indirectly by theneed for 'health monitoring'. Enhancement of the cooper-ation at administrative level is however highlighted as the'National Board of Health has primary responsibility forgeneral health monitoring, while the responsibilities ofother ministries are more linked to preventive initiativessuch as setting limit values and detailed requirements forthe different sources of environmental factors'. Enhancedcooperation between ministries is to ensure coordinatedand cohesive action against environmental factors thatcan affect health, and in particular within areas of com-mon interest are needed for the realisation of the strategyand action plan [9].

The European Environment and Health Action Plan2004–2010 stresses clearly the need for closer coordina-tion between the health and environment research areas[10,11]. The action plan identifies 13 actions with a focuson: improving the information chain by developing inte-grated environment and health information (Action 1–4),filling the knowledge gap by strengthening research onenvironment and health and identifying emerging issues(Action 5–8) and reviewing and adjusting risk reducingpolicy and improve communication (Action 9–13) [12].

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The ultimate goal of the European and the national strat-egies is to 'develop an environment and health cause-effectframework' that will provide the necessary information forthe development of policies dealing with sources andimpact pathways of health stressors.

Action 1 (Develop environmental health indicators) andAction 2 (Develop integrated monitoring of the environ-ment, including food, to allow the determination of rele-vant human exposure) of the European Environment andHealth Action Plan 2004–2010, concerns the health of theenvironment and integrated monitoring of environmen-tal contamination leading to human exposure, i.e. exter-nal human exposure. Action 3, currently underway,focuses on internal human exposure or human biomoni-toring. In the third action, the European Commissioncommits itself 'to develop in close cooperation with the Mem-ber States a coherent approach to Human Biomonitoring inEurope and to launch an EU Pilot Project to test out the feasi-bility of such a coordinated approach'. For this reason, anExpert team to Support BIOmonitoring (ESBIO) togetherwith the Implementation Group (IG) of the EuropeanHBM has been preparing implementation of an EU pilotproject, which was launched in the spring 2007. The back-ground and rationale for the EU Pilot Project and the Dan-ish proposal of a conceptual framework for a nationalHBM program (cf. Figure 1) are presented in this paper.The proposed framework builds on the principles andexperience gained from scientific work at national and EUlevel, e.g. NoMiracle, as well as environment and humanhealth indicator reporting within the area of cumulativerisk from exposure [7,13-19].

BackgroundIn the second recommendation from the ImplementationGroup (IG) and the final proposal for a European HBMproject, two scenario types, the so-called 'basic' and'extended' scenario, are described. The basic scenarioincludes mainly heavy metals (lead, mercury and cad-mium) and the metabolite cotinine from nicotine intobacco smoke, whereas the extended scenario includescontaminants, for example brominated flame retardants(BFRs), for which complex analytical methodologies arerequired.

Therefore, harmonization between countries may need toaddress both 1) quality assessment and assurance systemsin relation to analytical chemistry and methodologies and2) design and framework of the monitoring program forthe quantification of state and development in exposurefrom stressors suspected to contribute to the priority dis-eases included in the national and European environmentand health strategies. The two different levels of harmoni-zation required in the European pilot project may beviewed in terms of:

• A basic scenario monitoring program, where the mainpurpose is to secure data quality and comparability inanalytical methodologies across Europe, as well as toestablish reference values or data ranges for the Europeanpopulation, enabling comparison according to exposurescenarios. Knowledge transfer between countries bymeans of proficiency testing systems for the participatinglaboratories in order to attain quality harmonization maybe included here.

• An extended scenario, where the chemicals are selectedbased on a human health oriented framework approachand where the specific selection of chemicals may differbetween countries, i.e. according to national priorities.Knowledge transfer between countries in order to developa monitoring program designed to quantify trends andinformation needed to guide future environment andhealth priorities; i.e. an HBM framework including a sci-ence-policy interface, may be included here.

The basic scenario may not meet the requirements fornational priorities for all member states due to theincreased political concern directed at addressing high riskscenarios. Here, focus would be on high exposure poten-

Framework for a national integrated environmental and human health surveillance program and relations to DPSEEA (Driving forces – Pressures – State – Exposure – Effects – Actions)Figure 1Framework for a national integrated environmental and human health surveillance program and relations to DPSEEA (Driving forces – Pressures – State – Exposure – Effects – Actions). The black box in the middle of the figure repre-sents the national human biomonitoring program, which delivers outputs to support political targeted actions to pro-tect human health and the environment. The science-policy interfaces are illustrated by the arrows connection the grey and black boxes.

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tials combined with high toxicity potentials in specificscenarios addressing specific priority diseases.

The extended scenario would call for a harmonisationprocess that has already been suggested in the WHO initi-ative for an integrated environment and health informa-tion system. From 2007, the Member States report to theWHO on the status and progress on the national activitiesregarding children's environment and health http://www.euro.who.int/eehc/ctryinfo/ctryinfo.

The process of obtaining consensus on the health issuesand the selection criteria for chemicals to be monitored iscentral for the realization of the pilot project and in thisrespect some flexibility in interpretation of the word 'har-monization' may be useful. Harmonization may addressthe process in terms of the compounds to be monitoredenabling quality assurance and proficiency testingarrangement between countries. Alternatively, harmoni-zation may relate to development of a European frame-work for an approach to select biomarkers based onexisting structures and knowledge on environmentalquality and human health.

In order to meet the goals of the EU Environment andHealth Strategy and the conditions formulated in SCALE,the European Environment Agency recommends that[6,7,20-23]:

• an information strategy for the program should be builton policy relevant indicators addressing the main policyquestions [20,23]

• the focus of the monitoring and assessment effortsshould be on relevant exposures to environmental factors[21,22]

• harmonized arrangements for managing monitoringinformation should be developed [7]

An example of a compound group which would belong tothe extended scenario, and of broad international interest,is the BFRs which have been acknowledged as ubiquitouspersistent pollutants concerning bioaccumulation poten-tial and adverse health effects. Exponential increases havebeen found in human tissues since the 1970s, with indi-cations of stagnation in European samples, possibly as aconsequence of political regulation [24].

Danish initiatives and projectsThe Danish Environmental Research Institute publishesevery fourth year a state of the environment report forDenmark, including a chapter on environment andhealth, presenting status and development in knowledgeof the impact of environmental factor on human health

[16]. Focussing on BFRs, existing knowledge of externaland internal exposure was reviewed recently, with empha-sis on identification of exposure routes [25]; the studyconcluded that unintentional ingestion of dust is at leastof similar importance as food.

Analogous to e.g. the WHO's integrated information sys-tem http://www.who.dk/EHindicators/indicators/20040311_1; a national pilot project on the integration ofenvironmental data bases and population health registershas been performed at the national level, in Denmark. Theproject proposes that the geographically based healthdatabase of the National Board of Health, is utilised as thebasis for linkage of health and environmental registers[26].

Several research projects are addressing chemicals andbiomarkers focusing on the national priority diseases res-piratory disorders and allergy included in the NEHAP [9];e.g. COPSAC http://www.copsac.dk and AIPOLIFE http://www.airpolife.dk. Based on national collaborations, theDanish Board of Technology published a report, 'A betterenvironment for children – a proposal for action' [in Dan-ish], that recommended 14 actions to protect the health ofchildren, including the need for 'coordinating of environ-mental and health guidance in relation to children's exposureto hazardous environmental factors' and 'better systematic sur-veillance and risk assessment of the amount of environmentallyrelated health hazardous substances in food, consumer productsand drinking water' [27]. Several other activities regardingchildren's health, e.g. research studies on biomarkersaddressing childhood cancer and endocrine disruptorsand on children's exposure to BFRs, have been completedor commenced.

As a follow-up on the Fourth Ministerial Conference onEnvironment and Health in Budapest, 23–25 June 2004[23], the National Board of Health in Denmark publisheda collection of ideas regarding activities to improve chil-dren's environment and health in Denmark [28]. Theideas of this report have been presented to the DanishInterministerial Group for Environmental Factors andHealth, which was established in relation to the NationalEnvironment and Health Action Plan (NEHAP). One ofthe ideas of the report are to establish a systematic surveil-lance and risk assessment of chemicals with negativeeffects on health in consumer products, food and tapwater and to clarify the relation between environment andfood contaminants and related health effects on malereproductive organs [28].

Integration of available information on environmentaland human health trends may form the basis for a screen-ing level indicator system that can be used to design a bio-monitoring program. Thus, Environmental Health

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Indicators (EHI) identified scientifically are tools thatsummarize the relationship between the environmentand health, and these can be used for regulatory actions tomanage or prevent impacts on environment and health[13,14,17,23].

The proposal for a coordinated action involving existinginfrastructures, experts within environment and healthmonitoring activities, and research for the support andimplementation of a human biomonitoring program isan obvious continuation of the activities and cooperationthat have already taken place among institutions in Den-mark. Based on the experience with BFRs and qualityassurance/quality control, Denmark has taken a leadingrole in the design of appropriate monitoring strategiesand procedures of this compound group.

Conceptual framework for a Danish HBM programA HBM program should be a central part of any nationalintegrated environmental and human health surveillanceprogram, and there is a need to develop an interfacebetween the science and the policy decision support sys-tems – in SCALE denoted a 'response system'. To makethis interface as transparent as possible, we suggest riskscenario descriptions and selections (prioritization) toform the basis for human health oriented biomonitoringsurveys. The scenario selections will be based on hypoth-esis-driven risk scenario descriptions focusing on childrenas the most vulnerable sub-population. The scenariodescriptions deliver input to the prioritization of theexposure modelling of high-risk chemicals with respect tothe national and European priority diseases as well as the

biomonitoring and monitoring activities. The modellingof outdoor exposure is already included in the nationalmonitoring program of the environment [29], whereasthe indoor exposure needs to be monitored in addition tointernal exposure, i.e. biomarkers of exposure. This couldbe formulated as a minimum requirement for the outputfrom the basic scenario, as defined in the third recom-mendation from the Implementation Group.

When focusing on biomarkers of exposure, as in the basicscenario of the proposed pilot project, it is crucial for theadded value of the biomonitoring program that bothexposure routes and related internal exposures are moni-tored. This will allow for the ratio of external to internalconcentrations, i.e. C(external)/C(internal), by purposeof identifying science based 'safety-factors' with respect tolong-tern low dose exposures and re-evaluation of envi-ronmental quality criteria protect human health fromunacceptable aggregated exposures.

Results from the human biomonitoring program willfeedback into the prioritization of the monitoring strategy(cf. Figure 2), so that new knowledge concerning the linksbetween environmental quality and health outcome aremade available to secure future optimizations of the bio-monitoring strategy.

The science-policy interface of the programThe hypothesis-driven risk scenario analysis will be basedon integrated use of e.g. emission data, product informa-tion data, epidemiological data, air and drinking waterquality data combined with available knowledge on pos-sible human health effects. As such the risk scenario anal-

Biomonitoring framework to support the complex interaction between environmental quality and human health qualityFigure 2Biomonitoring framework to support the complex interaction between environmental quality and human health quality.

Developmentalstage

ReceptorIndividual,community,population

Strategy prioritizationand planning of

monitoring activitiesi, j

Toxicityi, j

Geneticsusceptibility

Internalexposurei

Earlyeffectj

Alteredstructurefunctionj

Healthoutcomej

Sourcei EmissioniExternal

exposurei

Markers ofsusceptibility

Markers ofexposure

Markers ofeffects

Healthstatus

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ysis is aims to cover all aspects of the DPSEEA (Drivingforces – Pressures – State – Exposure – Effects – Actions)chain [12].

DPSEEA defines driving forces (D), that lead to pressureson the environment (P), which in turn change the state ofthe environment (S), resulting in human exposures (E)and in turn health effects (E). Actions (A) may then betaken at any point in this chain to mitigate or avoidunwanted health effects [12]. The structure illustratedabove supports the development of information systemsas well as the compilation of adequate political measures.

Environmental factors that induce health effects need tobe investigated in order to support the selection of systemactions with respect to identified direct and indirect envi-ronmental exposure sources. Identification of source-emission-exposure relationships is crucial for theresponse system within the DPSEEA framework to beoperational for preventive actions for future protection ofintegrated environmental and human health aspects.

Dataflow within integrated environment and health monitoringFor bridging the gaps in science-based knowledge of thehealth effects caused by environmental stressors, biomon-itoring activities need to include environmental expo-sures, genetic susceptibility, diseases and/or disorders. Tosupport further targeted policy actions for preventing and/or reducing diseases related to environmental stressors,human biomonitoring activities need to be designed inresponse to hypothesis testing of existing relations. Thisshould also include available and emerging technologiesfor increasing the understanding of mechanisms causingunwanted health effects and routes of exposure related tospecific environmental factors, i.e. the E-E part of theDPSEEA.

Such hypothesis testing will take place by prioritization ofthe human biomonitoring strategy and design of moni-toring activities according to existing knowledge onsources, emissions, external exposures, toxicity of chemi-cal exposures, susceptibilities of population groups to dif-ferent types of diseases. Data flow and integration of newand existing knowledge as part of human biomonitoringframework is illustrated in Figure 2, which is described inthe following paragraphs.

The boxes with black bold borders illustrate elements ofan aggregated and cumulated exposure scenario (thesource-emission-exposure link) and internal exposure, orbiomarkers of exposure, as part of the human biomoni-toring activities. The description of exposure scenariosincludes identification of source and use categories, emis-sions and exposures. Additional chemical-specific proper-

ties may be taken into account addressing criticalexposure routes, as has for example been carried out forBRFs in which case unintentional ingestion of dust is sug-gested at least of similar importance to food intake [25].Likewise, existing fate models may be part of the exposuredescription of a given scenario type. External exposuremonitoring is included in the biomonitoring activitieswhere these data are needed to quantify the internal/exter-nal body exposure ratio as the combined monitoring highrisk exposure route concentrations, and biomonitoring isessential for realistic human health impact assessment.

The grey shaded boxes with black bold borders representcohort characteristics central for the hypothesis to betested; a central element is genetic susceptibility biomark-ers as part of the human biomonitoring activities.

The boxes with regular borders represent biomarkers ofeffects to be included in the human biomonitoring activi-ties and human health outcome, which is part of thehuman health impact assessment in Figure 1. Biomarkersof effects represent early warning indicators 'signallingevents in biological systems or samples', representingboth the environmental agent and the adverse healtheffect. Included are markers of 1) susceptibility, 2) pastand present exposure, 3) adverse effects and 4) specificdiseases.

The grey shaded box with regular border represents avail-able chemical toxicity data and may include all kinds oftoxicity data that may be used for an initial risk scenariodescription and i.e. planning of monitoring activities. Thebox includes the use of classification and grouping ofchemicals into similar modes of action.

To increase the transparency of how to support targetedpolicy for health protection, prevention or remedialactions, the links between scientific diagnostic healtheffects science and regulatory toxicity need to beaddressed. Refined hypotheses are developed based on anational environmental and human health informationsystem, giving an overview of research related to humanhealth diseases suspected to be caused by chemical stres-sors.

The hypothesis is tested based on external and internalmeasurements of chemical exposure, biomarkers of expo-sure, susceptibility and effects. The hypothesis can berefined by hypothesis testing biomarkers of effects to theprioritized health effects (specific or non-specific adversehealth effects) as illustrated by the iterative arrow from'Human Health Impact Assessment' to 'Hypothesis drivenrisk scenario Analysis' in Figure 1 – analogue, the arrowfrom 'health outcome' to the 'strategy prioritization andplanning of monitoring activities' in Figure 2.

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DiscussionBasic requirements for establishing a human biomonitor-ing program at the national and European level, describedin this paper, are based on the recommendations of vari-ous international agencies. The important parameters foran optimal biomonitoring program include: selection ofchemicals, exposure scenario and biological indicators(early warning indicators), which depend upon the targetendpoint under investigation. It is important to develop amethodologically well-structured framework for biomon-itoring activities that are able to support future optimalhypothesis testing of relationships between chemicalexposure profiles and health effects. The target populationgroups and subgroups, chemical pollution in a geograph-ical area and the genetic susceptibility of the populationunder study may affect selection of toxicological end-points, and thereby the selection of chemicals andbiomarkers may also be affected. Thus, the prioritizationof chemicals and biomarkers both at national and Euro-pean level will be required for optimal human biomoni-toring in Europe. The experiences from a pilot project onEuropean HBM would be able to establish scientifically-based selection criteria for various parameters. BFRs havebeen suggested as an important and optimal chemicalgroup to include in the extended scenario for monitoringpurposes and, based on existing data on external andinternal exposure, the identification of near-field sourcecontributions to exposures in aggregate. Such a pilotproject would also indicate other important factors whichshould be under strict control when an HBM is beingestablished in different Member States. This would con-tribute to harmonized HBM in Europe.

Competing interestsThe authors declare that they have no competing interests.

Authors' contributionsThe authors of the paper are all members of a Danishworking group that has made an effort to gather allnational main actors within human biomonitoringresearch in Denmark. The group prepared an expressionof interest for a Danish human biomonitoring pro-gramme to the relevant authorities and suggested a Dan-ish human biomonitoring programme at the same scale asthe existing National Monitoring and Assessment Pro-gramme for the Aquatic and Terrestrial Environment(NOVANA).

Marianne Thomsen has taken the initiative to write thispaper based on the experiences from the working groupand scientific projects such as e.g. NoMiracle, state of envi-ronment and health reporting projects and her involve-ment in the development of a coupled monitoring andassessment strategy for NOVANA. Hanne Bach, Peter B.Sørensen and Patrik Fauser have been involved in the

same projects and contributed mainly in the early phaseof this paper, with input on the structure of the paper and,more specifically, a cause-effect framework.

Lisbeth E. Knudsen contributed to the manuscript withher insights into human biomonitoring activities on thenational and European level, among others from partici-pation in the EU network "Expert team to support bio-monitoring in Europe (ESBIO)". Lisbeth E. Knudsen,Katrin Vorkamp, Marie Frederiksen and Marianne Thom-sen have been involved in related human biomonitoringactivities with focus on brominated flame retardants.Katrin Vorkamp has also contributed with experiencefrom NOVANA and the Arctic Monitoring and AssessmentProgramme (AMAP).

Suresh Rastogi has long term experience with near-fieldexposure from consumer products. Eva Bonefeld-Jør-gensen has likewise been active within human biomoni-toring for many years, among others within the HumanHealth Programme under AMAP. Teddy Krongaard coor-dinated the Danish expression of interest. All authorshave contributed to the manuscript with discussion andcomments.

AcknowledgementsThe authors acknowledge the support of the project ESBIO (Contract No: 022580) funded by the European Commission (Directorate-General Research) under the 6th Framework Programme for Research and Tech-nological Development in close cooperation with Directorate-General Environment.

This article has been published as part of Environmental Health Volume 7 Supplement 1, 2008: Ethics and communication in human biomonitoring: European perspectives. The full contents of the supplement are available online at http://www.ehjournal.net/supplements/7/S1.

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